Case Manager

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Oversee care, resources, and services for designated member populations

• Offer guidance and encourage efficient use and monitoring of healthcare resources

• Collaborate with members of the healthcare team to achieve optimal clinical and resource outcomes

• Conduct thorough assessments and coordinate treatment, interventions, and discharge planning

• Create member-focused plans based on individual needs, health status, education, and support requirements

• Identify obstacles to achieving goals and care plans

• Leverage community resources and funding sources

• Track and manage members through follow-ups, education, referrals, documentation, and plan adjustments

• Assess and facilitate care throughout the continuum, including physician offices, hospitals, rehabilitation units, skilled nursing facilities, and home care

• Educate members and promote proactive intervention

• Record assessments, plans, implementation, monitoring, and outcomes

• Reach out to high-risk, high-cost, or high-utilization members as necessary

• Review alternative treatment plans and evaluate benefits, exceptions, or flex benefit options

• Assess medical necessity and the appropriateness of services

• Formulate policies, procedures, education, or training as required

⛳️ Requirements

• RN with a minimum of 3 years of clinical and/or case management experience is required

• Must possess and maintain a valid and applicable clinical license (NC or compact multi-state licensure)

• Additional specialty certification may be necessary for certain roles, such as CCM or CDCES; relevant certification must be acquired within 2 years of employment if mandated

• At this moment, Blue Cross NC will not sponsor employment authorization for this position

• Additional non-compact state nursing licenses are strongly preferred

• Extensive clinical nursing experience across various care settings is highly desirable

• Skills: Care Plan Development, Care Planning, Clinical Outcomes, Health Care, Healthcare Utilization Management, Nursing Fundamentals, Patient Advocacy, Patient Care, Patient Care Coordination, Patient Evaluations

🏝️ Benefits

• Medical, dental, and vision insurance

• Health and wellness initiatives

• Parental leave and assistance

• Support for adoption and surrogacy

• Career advancement programs

• Tuition reimbursement for ongoing education

• 401k matching along with an annual company contribution

• Paid Time Off (PTO)

• Annual Incentive Bonus

• Flexible work arrangements

• Emphasis on work-life balance and autonomy